1) A person has a stroke after being completely independent in every daily living task and in mobility.

2) A person has a stroke after relying on a certain type of wheelchair for a while.

Look at the following two scenarios to get a better idea about what we are referring to here:

Katie is a 68 year old female residing at home with her husband and her two grand-children. Before sustaining a massive stroke, she was completely independent in everything. She was driving, running the majority of errands, cleaning her house, and working part-time as a teacher’s aide for a local preschool. She would also go on regular walks with her husband and her dog. It has been 6 months since her stroke, and after undergoing regular therapy she still has severe mobility limitations. She is unable to walk do to having no movement or sensation throughout her left leg, and she is unable to stabilize herself with a cane having no movement in her left arm. Her doctors are unsure about whether or not she will regain any function throughout her left side. She has never needed durable medical equipment (DME) before, but in order for her to get around better, she and her husband have considered getting her a wheelchair.

Joanna is a 52 year-old female who resides in condo with her roommate. For years, Joanna has relied on a manual wheelchair due to a congenital condition in which she was born with no feet. She is able to get around independently, complete her household and work-related tasks on her own. She drives with modified foot pedals and can complete all of her own transfers in and out of the chair. Last month, Joanna experienced a stroke that has paralyzed her right arm and her right leg. She has a lot of trouble sitting up straight and is very concerned about how she is going to continue to use her manual chair if she can’t propel with her right hand.

No matter what the circumstances are, a stroke can have devastating effects on an individual’s life and force them to seek out adaptive resources in order to maintain their quality of life. For the sake of simplicity, we will be focusing on just types of wheelchairs that either Katie or Joanna can research and apply for. In both cases, these women now have to complement their immobility with the right types of wheelchairs in order to continue participating in their usual lifestyles.

If both women would like to pursue a manual wheelchair, here are a few items they must consider:

One-arm Propulsion

Both Katie and Joanna are down one arm with no surety about regaining movement in their affected limbs. Thus, they have to consider the difficulties that come with propelling a chair with one arm. If Katie decides to get a standard manual wheelchair, she at least has the capacity to propel the chair with both her left leg and arm with some efficiency. Thankfully, there are wheelchairs available that suit the limitations that come with hemiplegia. Hemiplegic wheelchairs come with dual push rims on one wheel which allows for single-arm propulsion.

Functional Transfers

Both women may have to rely on someone else to assist them with getting in and out of their chairs due to the instability through their affected limbs. In Joanna’s case, she does not have two-arm lifting capacity available to push herself in and out of the chair. In order to transfer from the chairs, Katie and Joanna need frames that allow for them to easily reach the braking system. This can usually be resolved by putting a brake handle extender on the wheel next to their affected side, so that when they cross their arm over, they can reach it without falling out of the chair.

Limb Positioning

With hemiplegia comes unpredictable positioning of the limbs at rest. If Joanna and Katie are experience what is called flaccid hemiplegia, then their affected arms and legs will be constantly falling off of arm-rests and foot-rests. Some hemiplegic types of wheelchairs come with strapping systems in which they can slide the affected limbs into place without assistance. There are also custom arm and foot-rests with extra padding or supports in order to keep the limbs in place during propulsion.

Torso Support

It has been mentioned that Joanna has a difficult time sitting straight up, which is not uncommon for individuals post-stroke. There are several ways in which she can approach this problem, depending on how much external support she requires. She can incorporate a contour back support (with some concavity) combined with lateral supports that will force her upper body to stay upright in the chair. If it is a matter of falling forward in her chair, she can look into installing a safety harness with a 5-point system just as long as she can buckle and unbuckle the harness herself

Hip Placement And Seat Pressure

Stroke with hemiplegia often leads to abnormalities in the hips, which makes for uncomfortable, prolonged sitting. One side of the pelvic bone will experience more pressure in a seated position than the other side, which can cause for further misalignment or pressure sores. If asymmetrical sitting is going to be a problem for this women, they should consult with a specialist regarding the uneven pressure distribution and see about specialized wheelchair cushions that could improve their ride with these types of wheelchairs.

Powered Types of Wheelchairs – Considerations

Powered wheelchairs are a great option for individuals with hemiplegia since they can be operated single-handedly with a joystick. However, Katie and Joanna need to consider any vision/perceptual and cognitive side effects from the stroke. The best approach would to be to consult with their primary physicians or specialists to check their vision and cognition before attempting to operate a chair with a motor. Impaired perception or judgment while propelling powered types of wheelchairs could result in injury to themselves or to others.